| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,462 |
3,462 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
3,734 |
3,734 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,571 |
4,571 |
$74K |
| D0272 |
Bitewings - two radiographic images |
3,076 |
3,076 |
$58K |
| D1110 |
Prophylaxis - adult |
1,143 |
1,143 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
687 |
673 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
483 |
483 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
229 |
174 |
$18K |
| D0274 |
Bitewings - four radiographic images |
322 |
322 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
106 |
92 |
$8K |
| D0330 |
Panoramic radiographic image |
164 |
164 |
$8K |
| D1351 |
Sealant - per tooth |
202 |
57 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
373 |
368 |
$5K |
| D0240 |
|
245 |
240 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
50 |
30 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
115 |
115 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
99 |
$4K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
30 |
15 |
$2K |
| D2140 |
|
33 |
26 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
13 |
$2K |